I think the PVNS came as a surprise.
Pre op CT showed multifocal spurring and heterotopic ossification with
talar dome OCLs.
Now that the path is back, the request is “r/o recurrent PVNS”
I see what look like small scattered foci of PVNS in the FHL tendon sheath
and posterior ankle (red arrows).
My question is about the synovial thickening anteriorly.
I would think this is post-arthroscopic arthrofibrosis,* but can I be sure
there is no superimposed PVNS amidst this anterior ankle soft tissue
thickening*?
I don’t think the posterior ankle was entered…so I presume this is
residual rather than “recurrent” PVNS.
Clearly there was PVNS that was biopsied in the anterior ankle, so I don’t
know what’s what anteriorly.
There is only this outside Pre Op CT, I don’t know if there was a Pre-Op
MRI (I don’t have one).
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Hello,
Yes- residual/recurrent disease in ankle
There is 100% recurrence if only synovectomy is performed
At UTSW, additional treatments- radiation or tyrosinase inhibitors are always given in multifocal cases
Please see recurrence in a case of prior synovectomy- perfusion helps more than just contrast imaging to find these lesions everywhere
Avneesh Chhabra, M.D. M.B.A.
Associate Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>
http://www.utsouthwestern.edu<http://www.utsouthwestern.edu/>
________________________________
Sent: Tuesday, August 10, 2021 11:28 AM
EXTERNAL MAIL
I think the PVNS came as a surprise.
Pre op CT showed multifocal spurring and heterotopic ossification with talar dome OCLs.
Now that the path is back, the request is “r/o recurrent PVNS”
I see what look like small scattered foci of PVNS in the FHL tendon sheath and posterior ankle (red arrows).
My question is about the synovial thickening anteriorly.
I would think this is post-arthroscopic arthrofibrosis, but can I be sure there is no superimposed PVNS amidst this anterior ankle soft tissue thickening?
I don’t think the posterior ankle was entered…so I presume this is residual rather than “recurrent” PVNS.
Clearly there was PVNS that was biopsied in the anterior ankle, so I don’t know what’s what anteriorly.
There is only this outside Pre Op CT, I don’t know if there was a Pre-Op MRI (I don’t have one).
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